Pregnancy and childbirth

Over the past 30 years or more, I have had the great privilege of being included in the birth of a number of babies. Some with women who didn’t have their partner present and wanted a supportive birth companion, and some with women whose partner was there, but who felt they wanted some extra support. I’ve also been included in the births of my own children as well as my first grandchild. I have seen women pace and belly dance their way through labour (the origins of belly dancing) and give birth to their babies squatting, standing, laying on their side, semi-reclining and on all fours and watched as my wife delivered our last baby in ‘warrior pose’.

I have also been actively involved in a number of pregnancies and have worked with literally thousands of post-natal mothers and babies. During this time I have listened to many wonderful stories about pregnancies, empowered births and the joys that accompany the arrival of a new baby within the family. I have also heard numerous stories from mothers who have ended their relationship, or have ongoing unresolved issues with their partner, as a result of his ambivalence and lack of…

Commitment during her pregnancy

Pregnancy brings about many obvious changes in women, but not so obvious are the changes that it brings about in men. During the nine months of pregnancy this can include minor weight gain, morning sickness and disturbed sleep patterns. In more extreme cases labour pains known as sympathy pains are felt during the delivery of the baby.(Couvade Syndrome)

Hormonal changes that generate awareness of the impending reality of a new baby start some four weeks after the man learns that he is going to be a father. Around this time it’s not uncommon for the man to struggle with the thoughts of the huge life changes that the baby will bring. The increase in financial responsibility, the loss of individual freedom, the initial care and lack of sleep, and what effect a baby will have on the relationship between him and his partner are just a few of the issues likely to arise.

Some three weeks before the arrival of the baby male testosterone levels reduce. Lower testosterone levels are beneficial to a more harmonious family life. This lowers the risk of prostate cancer and contributes towards the longevity of the father and his willingness to become more involved with his child rather than to seek out new romances.

This is a time when learning and understanding more about what to expect in the coming months can create peace of mind. When being prepared will alleviate anxiety and allow the father-to-be to remain calm and supportive during his partner’s pregnancy and birth experience.

Strong bonds of affection are also needed to get through more difficult periods of childcare. Times like being awakened every two hours to feed a hungry newborn or pacing the floor with a fractious baby. Nature prepares for this and like the mother, the more you, the father, holds and cares for your child, the more connections you make for paternal behavior.

Fathers who are willing to become more informed and actively involved in making pregnancy, birth and early infancy a more positive experience, are far more likely to experience a happier partner, happier child, a more fulfilling sexual relationship and overall a happier life.

Alternatively, when the father to be remains ambivalent it can initiate high pre- and post-natal depression for both the man and the woman. This can lead to loss of confidence and lower energy levels with sustained feelings of unhappiness and a deterioration in the relationship between the partners during pregnancy and following childbirth.

For many men, the lack of recognition of the physical and physiological changes that their partner’s pregnancy is having upon them combined with their inability to assist in this momentous event can jeopardise the joys of having a child together. This can result in feelings of inadequacy, anxiety and jealousy causing increasing isolation as their partner’s pregnancy develops.

Modern medicine is a wonderful safety net, but pregnancy and childbirth is more a natural process than a medical condition. While a routine system of medical care is essential to keep check on the health of the mother and baby, greater recognition of the partner’s availability to provide a continuity of emotional and physical support can promote a more satisfactory relationship throughout this profoundly family-oriented period.

The presence of an informed supportive and loving partner during pregnancy, labour and childbirth can make all the difference to the mother and baby’s pre-birth and birth experience. A willing partner during labour can inspire more confidence in a woman’s natural ability to give birth.

The nine months of pregnancy is a timely opportunity for the father-to-be to learn exactly how to do this. How to best support his partner and actively assist her in preparing for labour and delivery and share more in the birth and care of their new baby.

‘Sharing Pregnancy’ a Free Download DVD and ‘Sharing Pregnancy’ a Free Download Information Booklet for partners is available on this website – see shop

For Fathers and Partners

Chapter 1: The first trimester

1. Along with the sense of anticipation and joy that mostly accompanies pregnancy, for the mother-to-be this time is inevitably punctuated by periods of doubt, physical discomfort and weariness, and it’s at moments like these that a considerate partner can provide a wealth of practical and emotional support. From just ‘lending an ear’ to making yourself available for household chores, start now to get involved in your partner’s pregnancy. The more you participate, the closer you will feel to your partner and baby.

No doubt you will also have doubts about being a father and your ability to help your partner during pregnancy and labour and birth. Keep in mind you also are experiencing hormonal changes to put you on alert. It’s quite common for your feelings of excitement and joy to also be mingled with anxiety, but this is the time to be, and be seen as a supportive partner and included as such by your partner’s health care providers.

Make the effort to share this experience, attend pre-natal appointments and watch DVDs about pregnancy, birth and parenting together– this will be of tremendous value to you both in the coming months. Encourage your partner to share her concerns and excitements about her pregnancy, and engage in open and honest discussion about what you are both experiencing.

2. Pregnancy can change a couple’s sexual relationship and both you and your partner will need to embrace these changes. For example, during the first trimester – the first three months of pregnancy – your partner’s breasts may increase in size and sensitivity. They are likely to become very tender and she may also experience nausea, extreme fatigue and ambivalence, all of which can serve to decrease her sexual desire.

If you want the best advice do not take any lack of desire personally. Start now and be more considerate and acknowledge your partner’s discomfort. Be available for hugs and kisses and make a real effort to ‘listen’ rather than to talk. Keep all lines of communication open and do not make sex a big issue at this time.

Generally sexual activity during pregnancy is not a risk to the baby, but hygiene is all important as your partner is more susceptible to vaginal and urinary infections. In the case of a persistent or transferable infection, the advice is to discontinue intercourse or use condoms.

3. Providing your lovemaking is not ‘rough’, sexual intercourse is generally considered safe throughout the whole of pregnancy unless your partner is aware of previous problems or during intercourse she experiences pain or bleeding. Under these circumstances always seek medical advice. Later in pregnancy, because of an increase in the blood supply to the pelvic area, a woman can experience longer-lasting orgasms. Lubrication can also be affected by hormonal changes but although many women experience an increase in secretions she may also experience a decrease. This will make intercourse very uncomfortable, and a water-soluble lubricant is recommended.

Should you have any questions about the safety of intercourse for your partner and baby at any time, consult with your doctor or midwife.

4. You cannot have a closer relationship to another human being than a baby in their mother’s womb. A life borne from a life the unborn child is nourished by the mother’s blood and bound to the mother in the closest possible way. The quality of the baby’s existence at this time will be influenced significantly by your loving support and the encouragement that you give your partner to rest, exercise and eat well and take good care of herself during pregnancy. Experiences in the womb are known to form deep unconscious patterns that will influence your child’s behaviour throughout childhood and later adult life. Although each child is unique they are affected by the caring attitudes of you and your partner in this fragile period of pre-natal life.

Throughout her pregnancy expect your partner to drift into quiet periods of rest and silent introspection. This is a necessary state of calm to relax both body and mind. Times like these encourage a beneficial state for both her and her baby. Learn to recognise and share in these periods. Give your partner space, and protect her from disruptive influences, like telephones and unwanted visitors. You will not feel excluded, and disconnected from your partner and baby if you acknowledge, share and support the changes that are taking place.

5. The nine months of pregnancy are a time of change from woman to mother and man to father. This amount of time is needed to develop more trust and confidence in your relationship with your partner, which will be all-important come your baby’s birth and beyond. Having a child is a family affair, and as a willing participant you can provide a wealth of physical and emotional support for your partner to enjoy pregnancy and encourage your baby’s birth to unfold as it should.

Massage and gentle stretching is highly beneficial during pregnancy, becoming even more effective because your partner’s muscles soften and relax more easily in preparation for giving birth. The woman’s feelings towards her pregnancy and your attitude towards her during this time will greatly influence the ease with which she carries her child. Your partner needs to feel safe and loved and you, especially, can make this possible. The more you participate the closer you get to your partner and baby.

6. The correct breathing rhythm, staying active and positioning the body correctly is all-important to pain relief during your partner’s labour. For example, a sudden pain in your lower back or belly can cause you to bend your knees and breathe very lightly with your upper chest. Lowering your centre of gravity and breathing in this way relieves the sensations that threaten to overwhelm you. Although, unlike sudden back pain, labour pains are not a signal that something is wrong. They can be extreme and at such a time will be managed better if your partner does the same and lowers her centre of gravity and uses the right breathing rhythm. Sharing and encouraging consistent practice of these breathing techniques is caring for your partner in a very special way.

Most important during these early months is relaxation, and the practice of abdominal breathing will promote deep relaxation and is a very effective antidote to any stress that you or your partner may be experiencing. Abdominal breathing is a most natural way to breathe and so easy to practise. Making the effort to do it is the most difficult part and this is where you can take the initiative to encourage regular practice. Practising now together will make this come far more naturally to your partner during her labour.

Abdominal breathing improves respiration, circulation and digestion and can help relieve any slight dizziness and nausea that your partner may feel during the early part of her pregnancy. It’s most important you encourage the practice of this as your partner will use this breathing rhythm to retain control of her labour at the beginning and at the end of each contraction.

7. Because your partner’s body softens during her pregnancy, if you do not already practice massage, then this is a perfect time to start. This can be done so easily just sitting together on cushions or a sofa.

Don’t be put off if you don’t know any ‘massage skills’ – your touch is what is needed and you have nine months in hand to practice and improve this with your partner. As your partner’s legs and feet take the most weight, massaging her feet and calf muscles as the baby gets heavier will help her relax and improve the circulation to the lower limbs.

Done now this can also help prevent and relieve swollen ankles. Start early and look for feedback and direction. Ask her if it feels good and if the touch is right. You are going to have to learn now how to take direction from your partner if you intend to be of real use to her during her labour.

From the end of the first trimester remind your partner not to lay on her back, especially if it makes her feel dizzy or unwell. In this position the uterus presses on the vein that returns blood from the lower body to the heart. Lying on the back for an extended period of time could restrict the flow of blood and nutrients to the placenta and the developing baby.

8. While many mothers proudly claim that giving birth is the most challenging and rewarding experience of a lifetime, common sense and research will tell you, that as with all extreme events prior preparation can make all the difference to a successful outcome.

It makes good sense therefore for you and your partner to acquaint yourselves fully with what to expect come the birth of your baby. This knowledge will help you to assist your partner in her efforts to keep labour and birth a natural process and for it to be as painless and uncomplicated as the situation will allow.

Get involved in the choice of birth attendant, physician or midwife and in the choice of where your baby will be born. The choice of a home or a hospital birth may well be determined as much by your partner’s health, age and medical history as by her personal preference.

Midwives tend to see pregnancy, labour and birth as a normal, healthy process, and they are experts at helping this to unfold with as few interventions as possible. Given an emergency they are trained to use appropriate interventions as and when necessary. Midwifery care offers your partner benefits with reduced risks. The benefits for your partner include a greater chance of having a vaginal birth without medical intervention and less risk of her or the baby having health problems after birth.

Obstetricians are specially trained to provide medical or surgical care to prevent or treat health problems in pregnancy and the complications that can occur in labour and birth. They take care of high-risk and also healthy, low-risk women, either directly or in collaboration with a midwife.

Chapter 2: The second trimester

9. During the second trimester, three to six months, your partner may find intercourse more enjoyable as at this stage of pregnancy the increased blood supply to the pelvic area may intensify sensations. This can be a good time to experiment with comfortable positions. The hormone oxytocin plays a huge role in sexual relationships. Both women and men release oxytocin during lovemaking – and not only is oxytocin released during orgasm, it appears to be responsible for causing orgasms in the first place. Oxytocin plays a huge role in human relationships and is released in response to a variety of stimuli including kind words and friendly gestures, but most of all in response to a ‘loving touch’.

As essential to childbirth as it is to orgasm, oxytocin triggers and regulates contractions of the womb and assists natural pain relief by initiating the release of endorphins, the body’s natural pain relievers. Known as the ‘cuddle hormone’, oxytocin is the reason why the brain is every bit as important as the womb during childbirth and a loving presence can influence a successful birth .

Oxytocin is the ‘bonding hormone’. It is responsible for establishing maternal and paternal behaviour and that initial bond between a mother and her baby. It plays a crucial role in giving birth and initiates the ‘let down reflex’, which allows the breast milk to flow and enables the mother to breastfeed. With new fathers oxytocin is present to initiate that surge of protective feeling that’s all important in the relationship between a father and his child.

You have only to watch a mother interact with her baby to see the powerful effects of oxytocin. Seen also with lovers, this is the hormone that helps to generate the most profound and amazing bonds.

10. Your partner has nine months to get the feel of her baby. Consciously and unconsciously from the moment of conception she is in touch with her baby, and as her baby grows and moves within her, these feelings develop. During this time you may notice your partner rubbing her belly to soothe and massage her baby. This is something women do instinctively when the baby begins to get too active.

Unlike the father whose relationship with the child at this time is sympathetic or ‘more of mind’, the mother’s relationship with the baby is empathetic and more to do with ‘sharing feelings’. Once your partner begins to feel her baby’s movements, this is a good time for you also to begin to do the same. Share in the joy of ‘getting in touch’ by laying your open relaxed hand or hands across your partner’s abdomen and feel the shape and movements of your baby. Later, from about 24 weeks, your unborn baby can hear and may well respond to your partner’s voice. From this time on, you also can put your mouth close to your partner’s abdomen and ‘talk’ to your baby, who is known to be especially receptive to the deep tone of a male voice.

11. The second trimester is the time to start to practice upper abdominal breathing, this is a slightly higher and faster breath. This will help your partner to retain control and breathe more rhythmically when in the grip of a contraction. Practicing both abdominal and upper abdominal breathing now will make these rhythms come far more naturally for your partner during labour.

The baby’s increasing size and weight may now begin to compress your partner’s abdominal organs and diaphragm. This can cause indigestion and more frequent passing of water. It can also cause more upper backache as the shoulders have to pull back to support the increasing weight of the baby.

The buttocks and lower back work particularly hard during the last trimesters as they support the increasing weight of the baby. Massaging and gently stretching around this area can relieve an aching back and fatigue. Combine lower and upper back massage now with the legs and feet. Upper and lower back and buttock massage can be done with your partner sitting the reverse way, resting her head on her forearms on the back of the chair. Legs and feet massage can be done relaxing on cushions or a sofa. Keep learning to take direction from your partner. Ask “Is this the right spot? Is the pressure OK?”

During labour your partner will have neither the time nor the inclination to be polite. She will direct you, as to when, where and how she needs to be touched and supported, probably without the niceties. So it’s just as well that you know and remember this in advance. The last thing a woman needs when in the grip of a contraction is for you to ‘take personally’ the way in which she talks to you. From the second trimester, keep encouraging your partner to practice her pelvic floor exercises and remind her not to lay on her back.

12. Your partner will need to feel relaxed and confident in her choice of birth partners. If she becomes stressed or frightened during her labour, her oxytocin levels decrease and her adrenaline levels can soar. This results in her contractions being less effective and her labour being more painful. Adrenaline triggers a fight or flight response and midwives recognise this response in frightened women, who can no longer cope with labour.

All too often this initiates a variety of medical treatment known as ‘a cascade of intervention’. This can start with an epidural for pain relief and then an intravenous drip of synthetic oxytocin to induce contractions. The synthetic version of oxytocin given to induce labour is not regulated as naturally as the natural hormone and this can distress both the mother and baby. A distressed baby will then need electronic fetal monitoring which can inhibit staying active and give rise to a far stronger possibility of a caesarean section and further medical treatment.

Your love and informed support during moments like this can turn a potentially

stressful experience into one of joy and empowerment for your partner. The timely release of oxytocin will play a major role in helping your partner to manage periods of stressful emotional and physiological responses, both during her pregnancy and especially during labour and childbirth.

This is a time when a loving partner can make all the difference. During labour, a little hands-on support and encouragement can help your partner maintain high levels of oxytocin, stay confident and relaxed between contractions and not to become stressed and afraid.

13. Because the birth environment can play such a critical role in your partner’s comfort level and progress of labour it will be up to you to try to keep the room quiet, calm and as private as possible to help her stay focused and relaxed enough to enable her to follow her body’s natural instincts.

People coming and going through the birth unit, loud or impersonal conversation and being surrounded by medical equipment can cause so much distress at such an intimate and sensitive time that it can change the course of labour with some very unpleasant results for both mother and baby.

Many birth units include the midwife and two supporting partners throughout labour and childbirth and your partner should be free to consider and choose the right birthing partners, who she wishes to be present at this time. It is better to choose partners who are ‘childbirth educated’, who know the most favourable positions in which to give birth and what choices need to made to assist labour.

As you are planning to be at the birth, choosing someone able to actively help you and your partner will most likely entail enlisting the help of a Doula or an Active Birth Teacher. Both are birth-educated companions, who will work in co-operation with you as a birthing partner to provide continuous hands-on support. Women have been serving other women in childbirth for centuries and this support from another woman has positive effects on the progression of labour. A good midwife and birth educated partners can make labour simpler and safer, and your ability to keep the oxcytocin flowing and provide emotional and physical support can make a world of difference.

14. A good Doula or Active Birth Teacher will protect your role and provide informed support. A good birthing partner is not there to replace you, but is there to support you so that you can focus on giving love and encouragement to your partner throughout this crucial time. Doulas and Active Birth Teachers will serve as an informed source of information throughout pregnancy, labour and birth and be able to assist you and your partner to gather information and options available during this time.It is important for you both to meet a few potential birth companions and to choose the one who you both feel the most comfortable with – one who will listen to your partner’s wishes and not bring her own agenda into the delivery room.

You would also be well advised to find out what your hospital’s newborn practices are ahead of time. Hospital routines involving a newly born baby should be minimal, so if your hospital policies require many routine interventions in the first hour of birth, consider choosing a different birth setting.

15. Wherever she decides to give birth, it will be easier for your partner to feel relaxed and comfortable and able to retain some control over the management of her labour. This will mean having the option to remain upright active and assume positions that she instinctively finds the most comfortable.

In order to ensure this freedom of movement during labour, your partner will need to gain the co-operation of the hospital unit or her midwife well before birth. Find out more about the beliefs and practices of midwives and birth units in your area, focusing on what is most important to you both. Ask your Doula or Active Birth Teacher, and friends or family members who have given birth, about their experiences with their midwife or chosen hospital.

Local childbirth educators or pregnancy support groups should also be able to tell you who gives the best care. You are both strongly advised to gain a fuller understanding of birth and obstetric practice from national childbirth organisations and local couples classes and gain information and assistance in formulating a birth plan.

Chapter 3: The third trimester

16. During the third trimester, the final three months of pregnancy, the growth of the baby can make it more difficult to find positions for making love. Now descending into the pelvis, the baby may press on your partner’s bladder and arouse sensations that she may find uncomfortable.

The size and weight of the baby will demand correct positioning and support for lovemaking, so you will need to be patient and try different positions until you find the most comfortable ones. The third trimester is a good time to be more creative and find other ways of making love. As the womb contracts rhythmically during an orgasm, an orgasm can also help to start labour if the birth of the baby is imminent or if the baby is overdue.

For many women the last days and weeks of pregnancy can be physically uncomfortable and emotionally fraught. Backaches and other pains will become more intense with the weight and size of the baby.

Frequent urination and the necessity of changing position will make a good night’s sleep well nigh impossible. All of which can make your partner fractious and increase her fears as to the health of her baby and her ability to cope with labour and motherhood.Here again is where you will make a huge difference. Be a good listener and encourage your partner to voice her concerns.Continue to massage and now include the practice of support in labour and birth positions.

Now is the time to include light upper chest breathing which will reduce the movement of the abdominal muscles and help your partner should she need to delay pushing her baby out before her cervix is fully dilated. Shallow upper chest breathing is associated with strenuous activity and will be useful in the later stages of labour. Practice this together with upper abdominal and abdominal breathing and encourage your partner to keep practicing pelvic floor exercises as these are particularly important in the time leading up to birth.

17. Provided there is no pre-existing medical condition to suggest otherwise, to make birth easier and prevent a tear encourage your partner to start very gentle manual stretching of her perineum from 36 weeks. This small space between the vagina and anus must expand enough to let through the baby’s head without tearing and this can make delivery easier.

Slouching during the last trimester can encourage the baby to turn face forward into a posterior position, one which is thought to make birth more difficult. Anterior positioning is when the baby is facing back towards the woman’s backbone and sitting upright and sitting upright resting forward can help the baby remain or move into an anterior position, which is considered far more favourable for birth.

If necessary remind your partner not to lie on her back and to stop any activity that is painful or makes her feel dizzy. Encourage adequate rest and relaxation and a good diet. Also to wear loose comfortable clothing and flat shoes to increase her comfort.

18. An estimated due date is just that, an estimate. On average most first-time mothers give birth a week after their due dates. If your partner has passed her estimated due date, remind her that her baby is making the final preparations for life outside her womb. Encourage her to remain active and reassure her that her baby will be born soon. Unless there is a sound medical explanation for induction, it is most often easier and safer to let labour begin on its own. Going against the natural process is not always easy and induction may initiate a variety of medical interventions because it forces the onset of labour.

Although they have everything they need to give birth naturally, many first-time mothers have obvious concerns about their ability to do it. You may need to remind your partner to make choices that support and assist her in labour and unless there is sound medical reason avoid practices that work against her body’s natural ability to give birth.

Medications offered to induce contractions can make contractions stronger, longer and more frequent than natural contractions. This will increase the mother’s pain and fatigue. The stronger and longer the pressure of induced labour, the more distress this can also cause the baby. This can then initiate heart-rate changes, which demand continuous electronic fetal monitoring. Monitoring the baby’s heart rate in this way will make it difficult for your partner to stay active.

If your partner’s labour is induced, it will most likely require an intravenous drip; this will also make it much harder for her to move and change positions to find comfort and pain relief as her labour progresses.

19. Sometimes, a medical condition or complication does make labour induction necessary. In such a case, induced labour may well be the safest choice for the baby, the mother, or both, despite its risks. Conditions where induction is thought safer than waiting for labour to start on its own include: when the waters have broken and labour has not begun within 12–24 hours; if your partner has health problems, such as diabetes or obstetric cholestasis, that could affect the baby; if she has an inter-uterine infection or the baby is growing too slowly.

If your partner’s pregnancy has been straightforward, she should be offered the choice of an induction after 41 weeks. If she decides not to be induced, it’s highly probable that she will go into labour spontaneously before 42 completed weeks. If your obstetrician suggests that she have an induction, it would be useful to find out whether this is because your hospital routinely induces women at a certain date, or whether the decision has been made on the basis of her individual circumstances.

20. To understand what is involved in giving birth, you must be present. Sharing in the intimacy of such an event cannot be explained it can only be experienced as it arouses a whole new depth of feeling. To be able to offer support at a time when your partner is at her most vulnerable will deepen your attachment and create a stronger foundation for a loving future together.

For a woman about to give birth, it is immensely reassuring to know that she can rely on the support of a birth-educated loving companion – a sympathetic partner who will respond when requested and is competent and able to offer physical support in the most comfortable positions during labour and childbirth – positions that will utilise the power of gravity to allow her pelvic muscles to stretch and the pelvic joints to open more easily to aid the descent of her baby. This combined with rhythmic breathing and, when needed, some gentle massage, creates the most favourable conditions for your partner to give birth in her own natural way.

Research confirms that the better the support a women receives, the easier their labour and the more satisfied they are with their birth experience. Feeling safe and cared for allows the brain to produce the right hormones that assists labour to progress naturally thereby decreasing the need for risky intervention.

21. Women often assume that a nurse, midwife or doctor will stay with them throughout their labour. However, the reality is that they have other duties which can keep them from being with one woman continuously. Doulas and Active Birth Teachers are professional labour support companions. They have received special training in labour support and share the philosophy that labour and birth are natural processes, and will strive to support these processes to ease labour for the woman as much as possible. Labour has proven to be safer and healthier when women are supported throughout the whole of this process, that women who have continuous support from trained companions are less likely to experience caesarean surgery, vacuum- or forceps-assisted delivery or other interventions.

You and an experienced birth companion knowing what to expect can offer the best in continuous emotional support and help your partner find more comfortable and productive positions throughout her labour.

22. This support will need to come in many ways to help for many reasons like reminding your partner to use the correct breathing rhythm and sharing in this with her; providing physical support, such as encouraging her to stay active; reminding her to lower her centre of gravity by bending her knees when in the grip of a contraction; massaging and rubbing her back as directed by her or helping her to get into a more comfortable position.Emotional support, such as an embrace, an arm around the shoulder with words of encouragement, praise and reassurance, to decrease stress and adrenaline. High levels of oxytocin and low levels of stress hormones support the progress of labour and reduce the intensity of pain a woman experiences.

Informational support from your chosen birth companion, such as explaining to a labouring woman what to expect, providing feedback about the progressIon of her labour, or helping her understand a recommended treatment increase your partner’s confidence and help her make informed, healthy choices as her labour progresses.

Chapter 4: Labour and childbirth

23. The World Health Organization and leading childbirth educators Lamaze International recommendations to support safe practice and assist a woman’s ability to give birth include;

Bring a loved one and a birth companion for continuous support.

Appoint birth companions who are birth educated – the people who are with you during labour and birth can make this process easier or more difficult.

Keep your baby with you – it’s best for you, your baby and breastfeeding.

Make sure you choose your midwife, birth unit and labour support companions carefully.

Choose a birth setting where the staff will support your birth choices.

Discuss your choice of birth with your birth team well before labour starts. That way, if necessary, there is time to change to a new provider or arrange for new labour support people who will better support your wishes.

24. While it is known that there are many benefits to allowing freedom of movement during labour, most women say they were unable to walk because they were connected to medical apparatus such as continuous electronic fetal monitors, intravenous lines (IVs), or both. So before agreeing to these interventions, it would be wise for your partner to know if they are absolutely essential and, if they are, then request for mobile devices that will still give her freedom of movement.

Research confirms that confining labouring women to bed increases their pain and decreases their satisfaction with their birth experience. There is no study that has shown staying upright and moving is detrimental to labour – that it will in any way slow labour down, increase the likelihood of caesarean surgery, or cause any harm to the mother or baby. On the contrary, walking during early labour helps keep labour moving and forward-leaning positions can help the baby rotate to an optimal position for birth.

Your partner will need space to walk around and a deep bath

or ‘birth’ pool to relax in, as well as a comfortable chair and perhaps a ‘gymnic or birth ball’ but most of all she will need a loving partner to hold her, rub her and boost her confidence when necessary, and provide informed active support to help her move and change positions to make her labour and giving birth easier.

25. If your partner is not giving birth at home, make sure the place she chooses to give birth will offer good support for you both. Enquire about their intervention rates. The intervention rates are among the most important factors that will determine the likelihood of your partner experiencing these interventions herself. The following intervention rates that most experts agree as acceptable are:

Caesarean section rate close to 15 per cent.

Induction rate close to 10 per cent.

Episiotomy rate close to 5 per cent.

Rates higher than these can indicate an increase risk of health problems without improving outcomes for mothers and babies. You will need to know, does your chosen place support walking, moving around and changing position, and does it encourage a labour support team, which include you and a professional birth companion.

Also what is their policy regarding:

Eating and drinking during labour.

Using intravenous lines (IVs) and monitoring the baby’s heartbeat.

Speeding up labour by breaking the waters or inducing labour with synthetic oxytocin.

The pushing stage of labour, episiotomies and care of the baby immediately after birth.

You will need to discuss all of this with your Midwife and Doula or Active Birth Teacher.

26. Walking, moving around and changing positions is proven to ease the pain of labour. Many women have confirmed that it was the ability to stay active and change positions that helped them through this period.

Movement makes labour easier because moving around during labour helps the womb work more efficiently. Changing position moves the bones of the pelvis to help the baby find the best fit through the birth canal and upright positions use gravity to help the baby descend. Upright, side-lying and forward-leaning positions allow plenty of blood flow to the baby, so there are less likely to be signs of distress. Staying active throughout labour can help your partner feel more in control, more confident and less afraid.

During the first stages most women like to walk and stay upright. Remind your partner to bend her knees and lower her centre of gravity and breathe during contractions. Encourage her to trust in and be guided by her body. The movements that your partner finds the most intuitive are the ones most likely to assist her labour.

27. Many hospitals and birth units have protocols that lead to routine interventions regardless of any risk assessment. So it is best to choose a birth unit that has low intervention rates. Disrupting labour by using interventions with women who are unlikely to benefit from them makes labour less safe and more difficult. Avoid medical intervention unless it is absolutely necessary. For a woman to surrender herself to hospital protocol at such a time is not the easiest option.

Certainly, some women need interventions in labour and, if this situation should arise, you and your partner should be able to make an informed choice with the knowledge that there is no safer alternative and the likely benefits outweigh the possible risks. Unless absolutely necessary, an intervention can disrupt the rhythm of your partner’s labour and make it more difficult and complicated.

All of these interventions have side effects, and research does not support their routine use on healthy labouring women. This is a time when you may need to ask the right questions as to why intervention is necessary and convey your partner’s requests to the health care staff.

28. Artificial rupture of the membranes or breaking the waters is one way to try to speed up labour. The bag of amniotic fluid that surrounds the baby in the womb usually breaks on its own once active labour has started. Until then, it softens the impact of the pressure from contractions on the baby and umbilical cord, protects the baby from infections, and is thought to help the baby rotate to come down through the mother’s pelvis. If the membranes are ruptured artificially, the baby no longer has these advantages. This can increase the pain many women experience, probably because the baby’s head, rather than the softer cushion of fluid, is pressing on the cervix, and increase the risk of uterine infection.

29. Continuous electronic fetal monitoring is where two electronic discs called transducers are held in place across the abdomen with wide, stretchy bands that circle the torso. One monitors the baby’s heartbeat and the other tracks the mother’s contractions. The transducers are connected to a machine next to the bed, which records this information. The monitoring itself isn’t painful but it can be quite uncomfortable to have the transducers strapped to the belly during labour. It means the woman must remain on her back, a position ill advised during pregnancy and being tied to a monitor in this way limits movement and confines the woman to bed, all of which will make it far harder for her to cope with contractions.

It also can distract the labour support team, who most often become preoccupied with the machine itself. Many studies confirm that continuous electronic fetal monitoring in low-risk pregnancies does not lead to healthier babies. Yet, continuous monitoring doubles the likelihood of caesarean section and is associated with more forceps and vacuum-assisted deliveries.

Unless circumstances arise to indicate otherwise, listening to the baby’s heartbeat periodically during labour is just as safe for babies and safer for mothers. And it does not interfere with a woman’s ability to stay active and change positions during labour. Continuous electronic fetal monitoring is usually carried out when a synthetic oxytocin drip is used to speed up labour. If your partner should need continuous fetal monitoring, request portable monitoring equipment that will allow her to remain active.

Comfort measures like hands-on partner contact, drinking water and having intermittent monitoring can help avoid unnecessary interventions.

30. induction as in speeding up labour is not easier or safer if it is done artificially. A common method of speeding up labour is using an intravenous artificial form of oxytocin. This will make labour contractions longer, stronger and more frequent, which can be stressful for your partner and her baby. She will then also require continuous electronic fetal monitoring so nursing staff can assess if the contractions are more than the baby can safely handle.

This apparatus will limit your partner’s ability to stay active and use positions to cope with her labour. Combined with stronger, longer contractions this will increase her need for an epidural. This whole situation usually arises when the release of oxytocin, essential to childbirth and naturally released by the brain, becomes disturbed.

31. Labour is easier and safer when your partner has enough fluids, electrolytes (salts) and calories. Your partner can safely obtain these from carefully selected nutritious light food, water and herbal teas. Keep in mind that if labour progresses spontaneously, voluntary muscles are at rest and your partner will not benefit from having high-energy sugar soft drinks that raise adrenaline-type hormone levels.

However some hospitals restrict women from eating and drinking, and insist fluids and nutrients be given intravenously. There is no evidence that this approach is safer for women, and some women find drips invasive, painful and stressful. The apparatus makes it difficult to change positions and move around freely, and a medical ‘drip’ does not give the same kind of comfort as that of eating and drinking.

32. Epidural is when a fine needle is inserted into an area of the spine known as the ‘epidural space’ to inject anaesthetic medication. It provides effective pain relief by blocking the nerve roots in the spine that lead to the lower part of the body. An epidural can make it harder for a baby to rotate to a position that fits easily through the pelvis. The baby is more likely to end up in a posterior position even if he/she was not in that position at the start of labour.

This will make it more difficult for your partner to use movement and position changes that help her labour to progress. It will make it harder for your partner to feel and respond to her body’s normal urge to push. This means there’s more chance of longer pushing stages and the baby being born by forceps or vacuum-assisted delivery. If your partner requests an epidural, she’s more likely to need her labour speeded up with a synthetic oxytocin drip.

Your partner should be offered the chance to have a longer, slower labour, before drugs are administered to speed it up. For women with particularly long or difficult labours, easing the pain of labour is known to help ensure a healthy vaginal birth.

One way to increase your partner’s likelihood of giving birth vaginally with an epidural is for her to wait for the urge to push before beginning to bear down. This may take a while longer as during this time it is the force of her contractions alone that bring the baby down and rotate the baby’s head into the best position.

Help your partner into a side-lying or an upright position, such as supported sitting, squatting or being on all fours. Most women with epidurals can use these positions but will need assistance. Women who give birth using upright positions have a shorter pushing time and less severe pain than women who give birth while lying on their backs.

33. Episiotomy is a surgical cut given to enlarge the opening of a woman’s vagina during birth. An episiotomy actually makes recovery from birth more difficult. Pain after the birth is worse and lasts longer in women with episiotomies than those who have natural tears. Since some women don’t tear at all, an episiotomy might create a wound that could have been avoided entirely.

Episiotomies also affect the strength of the muscles in the perineum, which is the skin and muscle between the vagina and the anus – this may later lead to problems of incontinence. Letting labour progress at its own pace makes natural methods more effective and can make birth easier and prevent the need for an episiotomy. Provided there is no pre-existing medical condition to suggest otherwise very gentle manual stretching of the perineum from 36 weeks will help let through the baby’s head without tearing and make delivery easier.

Early labour is usually the longest but the least intense. Varying from a few hours to a few days as the woman’s cervix thins out and dilates to 3–4 cm.. If the pregnancy is full-term you can expect your partner’s contractions to gradually become longer, stronger, and closer together. Starting with mild to moderate lasting about 30–45 seconds spaced about 5–20 minutes apart or longer these contractions will eventually come every five minutes and last 40 to 60 seconds each towards the end of early labour. Some women have much more frequent contractions during this phase, but the contractions will still tend to be relatively mild and last no more than a minute.

Sometimes early labour contractions are quite painful and they dilate the cervix more slowly than anticipated but generally early contractions are not as intense as those that follow.There may also be ‘a show’ which is a vaginal discharge sometimes tinged with blood and it’s likely that at this time your partner’s waters will break. This is generally the time to call your midwife and chosen professional birth companion. However you must always call your midwife if the waters break without contractions and / or if there is a strong show of blood.

When to call your midwife and companion is something you will need to discuss ahead of time at prenatal visits. Unless advised differently most early labour is best done at home and this ends when your partners cervix is about 4 centimeters dilated and her labour starts to accelerate.

In early labour the emotional reaction is usually one of excitement and both you and your partner will likely feel elated, excited and nervous. If you have not planned for a home birth, having called your birth unit to keep them informed wait a while before going there. Share and enjoy this time together. Ensure your partner stays active and eats, rests and breathes well. At first she may be able to talk through contractions and stay active around the house. She may even feel like taking a short walk with you but if not perhaps a warm bath, watch a video and to rest between contractions.

Active labour is when contractions become longer and stronger increasing in intensity and frequency, As your partner enters active labour, her contractions become more intense and last longer Your partner will now begin to anticipate a contraction and feel it building and then releasing. Most likely she will reach a stage where she can no longer talk or walk through the contractions any more. Coming some 3–5 minutes apart now and continuing for about 45–60 seconds labour will now be more rhythmic and obvious and will need her undivided attention both during and after each contraction.The cervix will now dilate more quickly and towards the end of active labour the baby may even begin to descend.

Excitement will give way to seriousness and an attitude of self-absorption. Concentration is now required with each contraction as she has to make a real effort to relax and breathe. Keep working with your partner and follow her cues and demands, stay with her and try to help her to stay with the contractions and maintain a rhythm. Help her to relax and remain confident in her natural ability to do this.

During contractions remind her to bend her knees and lower her centre of gravity – she may need your physical support to do this. Between contractions, encourage your partner to stay active. Breathe with her and walk with her. Make sure she continues to pass water regularly. Rub her back and offer a damp cloth to cool her face.

35. Transitional labour is when your partner is moving from the first stage, during which she has stretched the pelvic passages open – into the second ‘pushing’ stage. Transition is usually the most intense phase of labour but it’s also the shortest, most often lasting only 15–90 minutes. Many women do not experience more than 10 or 20 contractions during transition. Transition contractions are more frequent than those of active labour – 1-3 minutes apart – and will last at least 60–90 seconds as your partner’s cervix dilates to the 10 cm needed for her to give birth.

Now she may well start being uncertain and indecisive and no longer sure of what she wants and how well she is doing. As a result she may start to lose confidence in her ability to continue. Her contractions may be 90 seconds long with a reduced rest period between them with her ability to relax and rest severely challenged. She may have hot and/or cold flushes, start to shake, vomit, and/or not want to be touched. This is when relaxation is most helpful and the prime goal for you now is to help your partner to breathe out, let go and focus on relaxing her body.

The hurdle here is an emotional one and if your partner starts to lose her rhythm and her confidence, then this is the time she needs you to be strong and give her all of your support, positive encouragement and confidence. Even though having limited experience it may be difficult for you to have confidence in labour and birth, you have prepared for this so remind your partner that the last lap is often the hardest and show her how much you believe in her and in her ability to do this.

At this point she may well need you to lead and although staying upright and walking seems to be the most preferred positions during the outset of labour, in the stage of transition your partner is more likely to prefer to go on to all fours or to lay on her side. Both of these positions are useful in the second, pushing stage of labour, along with upright supported positions like semi-squatting and squatting.

Giving birth lying on the back is a position that is rarely comfortable and can prove to be unsafe for the baby. This position is not supported by gravity, it makes it more difficult for the gliding joints at the base of the spine, to open and let the baby through the birth canal, and it can compress the blood vessels that bring oxygen to the baby, resulting in the baby becoming distressed.

In this stage of labour, pushing while lying on her back means your partner is literally pushing uphill. The advice to your partner not to lie on her back during late pregnancy is given because this position can reduce blood flow to the baby. This same advice applies during labour. A baby is more likely to show signs of distress when the mother is flat on her back while pushing.

If she stays off her back and uses more helpful positions, such as standing, kneeling, squatting, supported kneeling and supported squatting, or lying on her side, she utilises gravity, the most powerful force on earth, to her advantage. This allows the birth canal to stay unrestricted and open to help the baby descend. It can make the entire pushing phase of labour shorter, and easier for her and her baby.

Some women begin to bear down spontaneously – to “push” – and may start making deep guttural sounds. Some babies descend earlier and the mom feels the urge to push before she’s fully dilated. Other babies don’t descend until later, it’s different for every woman and every birth.

Whether or not you’re partner is planning to receive medication, lots of gentle encouragement, relaxation techniques like body positioning breathing exercises and visualization will all help her during labour.

If your partner requests an epidural, the pressure she will feel will depend on the type and amount of medication she’s given and how low the baby is in her pelvis. If she would like to play a more active role in the pushing stage, she should ask to have the epidural dose lowered at the end of transition.

During transition some women prefer to focus their concentration inwards and do not want touch or any other stimulus that may detract them from their efforts in dealing with the contractions and the visualization of their baby descending. Others however may find relief in touch and massage. If so take direction as to where and how she wants to be touched.

The right touch will be all important at this stage so be sure to listen, be patient and get it right. Also a change of position may help and if your partner is experiencing some intense lower back pressure, moving onto an all fours should bring relief.

This is a time when she will need her birthing partners to give her timely reminders as to what a great job she’s doing and how close now is her baby’s arrival to assist her through transition one contraction at a time.

36. Best to encourage your partner to discuss this stage with her midwife well before labour, and share her wishes to use upright positions and spontaneous, non-directed pushing. It is unnatural for a woman giving birth to be on her back with her legs propped up in the air, holding her breath and pushing while others count and tell her to push harder.

Pushing spontaneously is when a woman follows her own body’s instincts during the pushing stage of labour. To push when she feels a strong urge to do so, and hold her breath for only short periods of time, if at all. Once the woman’s cervix is fully dilated second stage of labor, the final descent and birth of the baby, begins. At the beginning of the second stage, the contractions may come a little further apart, giving the chance for a much-needed rest between them.

Many women find their contractions in the second stage easier to handle than the contractions in active labor because bearing down offers some relief. Others don’t like the sensation of pushing.Pushing when and how her body tells her means she is pushing just the way that she needs to give birth. Pushing harder, longer or more often than she needs to can be exhausting, and put more forceful pressure on the baby and the muscles and tissues of her pelvic floor.

Not surprisingly, this increased pressure may cause stress for the baby and damage to the pelvic floor. If her baby is very low in her pelvis, your partner may feel an urge to push early in the second stage but if her baby’s still relatively high, she probably won’t have this sensation right away.

Upright pushing positions use gravity to your partner’s advantage. When it is time to push, encourage your partner to adopt whatever position feels best, and remind her birth partners if she wishes to follow her own urges that she will ask for support and direction if she needs it.

The midwife will usually give the correct feedback at this stage. Rather than giving instructions, let your partner know she’s doing a great job, and remind her that she knows just how to birth her baby. Your midwife may even show her the baby’s head in a mirror or encourage her to touch it as it begins to emerge. Try redirection when your partner seems discouraged or uncomfortable and suggest different positions, like all fours or holding on to you in one of the squatting or semi-squatting positions that you’ve practised together.

As her uterus contracts, it exerts pressure on her baby, moving him/her down the birth canal. When a contraction is over and her uterus is relaxed, her baby’s head will recede slightly in a “two steps forward, one step back” kind of progression. If everything is going well, she might want to take it slowly and let her uterus do the work until she feels the urge to push. Waiting a while can leave her less exhausted and frustrated in the end.

Most birth units have adjustable beds that support a variety of upright pushing positions. Adjust the bed to help your partner experiment with different positions, such as squatting, kneeling, semi-reclining or on all fours with her head leaning towards the head of the bed.

In many hospitals, however, it’s routine practice to ‘coach’ women to push with each contraction in an effort to speed up the baby’s descent – so it’s best your partner lets her birth companions know in advance if she would prefer to wait until feeling the spontaneous urge to bear down.If your partner has had an epidural, the loss of sensation can blunt the urge to push, so she may not feel it until her baby’s head has descended quite a bit. Patience can work wonders but in some cases explicit directions are needed to assist the woman to push effectively.

Chapter 5: Birth

37. The entire body of research on positioning in the pushing stage found that women who gave birth using upright positions had a shorter pushing time and less severe pain than women who gave birth while lying on their backs. The benefits of upright pushing include a shorter second stage of labour, a possible reduction in forceps or vacuum-assisted delivery, less severe pain, fewer abnormal foetal heart-rate patterns, fewer episiotomies, and less damage to the vagina and perineum.

Research also suggests that spontaneous pushing is more beneficial than coached pushing. The benefits of spontaneous pushing including less damage to the perineum, stronger pelvic floor muscles several months after the birth (this may reduce incontinence), and fewer abnormal foetal heart-rate changes.

After a time, her perineum will begin to bulge with each contraction, and before long the top of her baby’s head becomes visible, a sign that his/her birth imminent. Now the urge to push becomes even more compelling and with each contraction, more and more of her baby’s head becomes visible.

The baby’s head continues to advance with each push until it “crowns” – the time when the widest part of the head is finally visible and the baby emerges. At this time he or she be lifted onto your partners bare belly so you can both touch, kiss, and simply marvel. Your partner may well experience euphoria, awe, pride, disbelief, excitement and intense relief that it’s all over, and you can congratulate your partner in every way that you know how!

40. delayed clamping of the umbilical cord will need to be discussed with your midwife prior to your baby’s birth. The importance of this is that it allows more umbilical cord blood and crucial stem cells to transfer from mother to baby. As long as the cord is pulsing, the baby is still getting everything needed. In most cases, the cord will shut down on its own after two or three minutes at which time it can be clamped.

The biological unity maintained by mother and child throughout pregnancy does not cease, but becomes even more intensely functional following birth. Unless there is a medical emergency mother and baby should remain together with no hurry to clamp the umbilical cord. The cord can be left until it stops pulsating and your baby is then able to breathe independently. It used to be common practice to cut the cord immediately after the baby was born, until it was shown that premature cutting of the umbilical cord carries some serious risks.

Oxygenated blood in the umbilical cord and placenta will sustain the newborn for many minutes after birth; this may prevent brain damage or death if your baby is unable to adapt to breathing immediately upon birth. As your baby tries to breathe for the first time, additional blood volume is needed to fill the blood vessels that go to the lungs to pick up oxygen.

Normally, a baby gradually reroutes its circulatory system to take advantage of oxygen in the lungs as reliance on oxygen from the umbilical cord is gradually reduced. Abrupt reduction in oxygen levels caused by premature cutting of the umbilical cord may interfere with the way a baby closes valves in their heart at the time of birth.

Some benefits of waiting to clamp the umbilical connection include:

A far nicer welcome into our world. The first message being that you can breathe easy, this world will continue to meet your needs, rather than you having to fight for your survival;

Higher iron stores and lower incidence of anaemia;

Less morbidity and mortality from Respiratory Distress Syndrome (RDS), especially in premature infants;

Delayed cord clamping has been shown to be especially beneficial with premature babies, including reductions in Respiratory Distress Syndrome (RDS), blood transfusions and organ damage.

Late cord clamping is another example of how non-intervention, in a non-emergency situation, can result in long-term far-reaching health benefits.

Delivering the placenta

During the third stage of labour, oxytocin helps to ensure that the placenta and membranes are delivered.

Following birth, oxytocin levels are often higher this being an essential ingredient in mother and child bonding. It also helps to protect the mother causing the womb to contract and stop bleeding. The first few contractions usually separate the placenta from the uterine wall. On average, the third stage of labor takes about five to ten minutes. When your midwife sees signs of separation, she may ask your partner to gently push to help expel the placenta. This is usually one short push that’s generally neither difficult nor painful.

If your partner is planning to breastfeed, she can do so now as the baby suckling on the mother’s breast also contracts her womb to aid delivery of the placenta. Early nursing is good for the baby and can be deeply satisfying for the mother. What’s more, nursing triggers the release of oxytocin, the same hormone that causes contractions, which helps her uterus stay firm and contracted.

Contractions at this point are relatively mild. By now the mother’s focus has shifted to her baby, and may well be fairly oblivious to everything else going on around.With a first baby, she may feel only a few contractions after delivering the placenta. If she has given birth before, she may feel occasional contractions for another day or two.

She may also have the chills or feel very shaky. This is perfectly normal and won’t last long. Don’t hesitate to ask for a warm blanket if she needs one.

You and your partner will no doubt want to share this special time with each other as you both get in touch with your new baby.

Chapter 6: Following birth

38. Within their mother’s womb, babies are kept at the perfect temperature, and receive all they need to support life through their umbilical connection. During the nine months confinement babies are fed, nurtured, embraced and protected by their mothers. At birth the baby is still receiving the mother’s support because the contractions of the womb stimulate the baby’s nervous system and all the major organs needed for them to survive outside of their mother’s womb. These contractions are the baby’s first and most profound introduction to massage.

Human babies, compared with all other mammals, are born prematurely. The only reason we are born when we are is because if we stayed in our mother’s womb for longer our heads would not be able to pass though the birth canal. Now outside the womb but still connected to the mother through the umbilical cord, the baby can go from their mother’s womb to their mother’s arms.

41. From birth onwards the skin-to-skin contact with the mother initiates a hormonal exchange between mother and child which regulates the baby’s vital rhythms. Skin to skin contact between a mother and her baby can alter the child’s hormone levels, cardiovascular function, sleep rhythms, immune function, and more. With babies it shows itself to be interdependent upon the physical presence of the mother, at times the natural rythms of her body being vital to the maintenance of her baby’s physical and emotional health.

In premature babies, for example, it’s been shown that the temperature of a baby in an incubator, even though the incubator remains warm, can be lower than the temperature of a baby placed on the mother. It’s known that the mother’s temperature will rise a whole degree in order to raise her baby’s temperature, or similarly will drop if her baby’s temperature needs to be lower. This mother and child interaction is known as ‘thermal synchrony’. Similarly there is a breathing dysfunction known as ‘periodic breathing’, which is thought to be normal among premature babies placed in incubators. However, this abnormality disappears once the baby is held by the mother. The rhythm of the baby’s heart has also been shown to regulate around the mother and even sleep rhythms have been shown to be more synchronized when the mother and baby have consistent bodily contact.

During birth there is also an increase in the level of endorphins in the foetus, so that in the moments following birth both mother and baby are under the effects of opiates. The role of these hormones is to encourage dependency, which ensures a strong attachment between mother and infant. In child- situations of failed affectionate bonding between mother and baby there will be a deficiency of the appropriate hormones.

42. Fortunately, every change required for your baby to safely make the transition to the outside world happens quite easily when basic needs are met; the need to be held in the mother’s arms, skin to skin, with nothing in between. The familiar sounds, smells and tastes, and the perfect warmth of a mother’s skin help the baby to feel safe and sound.

In the first hour of life, scientific research confirms what every new mother knows – that it is essential for the mother and baby to remain together. This is the hour or so after birth when the newborn baby, if unaffected by anaesthetic and separation from his mother, will crawl intuitively to the mother’s breast and start to suckle. It is the baby who chooses to breastfeed and given this choice makes breastfeeding far less complicated. We used to think that mothers had to teach their babies how to breastfeed. (Many midwives used to push the baby’s face into the mothers breast to get the baby to latch on, some still do.)

Current research, however, shows that the baby is born knowing how to breastfeed and that, given the opportunity, it is the baby who can teach the mother. All the mother has to do is to lay her newborn baby in the right position, one which will give her baby access to her breast.

This can be done immediately after birth, simply by laying the baby face down on the mother’s tummy, with the baby’s head and shoulders on her chest. Guided by a sense of smell and given time, the newborn baby will kick and arch and without help will find his way to his mother’s breast and latch on and feed. The baby also knows how to suckle, which soothes and calms the baby and prepares the intestines to absorb and digest the milk that follows.

43. None of the routine newborn procedures, such as suctioning the baby’s nose and mouth, weighing and measuring, or wrapping in blankets, is more important for the new baby at this time, than having skin-to-skin contact with the mother. So if it cannot be done while the baby is skin to skin, try to avoid it. If your partner holds her baby skin to skin, it will naturally support breastfeeding. Talk with your partner and find out what your hospital’s newborn practices are ahead of time, and tell your birth unit/midwife that your partner plans to keep the baby skin to skin after birth and remain with the baby for the rest of the stay.

If the birth unit’s policies demand premature cutting of the umbilical cord and separation of mother and baby for other routines in the first hour of birth, you should consider choosing a different birth setting. Following the exertions of giving birth, your partner will probably be on a natural high from being able to see and hold the baby and the accomplishment of such a gymnastic feat. Following this, though, it’s quite natural that your partner will be very tired.

Research shows that women are likely to get just as much sleep with their baby in the room as they would if the baby was placed in a nursery. If your partner is going to remain in the unit overnight, make the effort to stay with her. This is one of those times when your support will be of much value to both mother and baby and give you and your child some time to ‘get in touch’.

44. ‘For the baby, his mother is unique, without parallel, laid down unalterably for a whole lifetime, as the first and strongest love object and as the prototype of all later love relations for both sexes.’

Sigmund Freud

A BIRTH PLAN

Your partner’s birth plan is a document to describe how, given the right circumstances, she would like her labour and giving birth to be. It is essential that if you are going to support your partner, you both review the options and agree these together. Make a few copies and give one to the midwife/birth unit ahead of time – this will help you to assess how much they will co-operate in order to fulfil your partner’s wishes. Your partner should name and date the birth plan and then make sure it includes any requests that she feels will help her through labour and giving birth.

As an example of a birth plan:
Name:___________________________
Date:___________________________
Address:________________________

I have prepared myself for a birth that is as safe and healthy as possible and prefer that interventions only be used as a last resort, if at all. I plan to be actively involved in all decisions related to my labour and birth and request clear and open communication between myself and all medical support staff. While I know that I may need to respond to unexpected situations, this birth plan reflects my current intentions. Thank you for helping me have a safe, healthy and satisfying birth.

I would like my labour to begin on its own, unless there is a medical reason why induction would be safer.

I plan to walk, move around and change positions throughout my labour.

Other comfort techniques I would like to use:

I plan to have continuous labour support from my partner and birthing partner.

Names___________________________

My plan is to minimise interventions during my labour and birth. I would like my labour room to be as calm as possible.

I would like to avoid routine interventions and that these only be given if there is a sound medical reason and an assurance that they are safer than a low-tech alternative or doing nothing.

I do not wish for continuous electronic fetal monitoring – I would prefer intermittent monitoring which will allow me more freedom of movement.

I do not want my waters broken or my contractions artificially induced. I would like my labour to begin spontaneously and progress at its own rhythm.

I prefer to eat and drink rather than be given an intravenous line.

I do not want an epidural analgesia or an episiotomy unless I ask for it.

I don’t want to give birth on my back, and I would prefer to follow my body’s instincts to find a position and push.

I wish for my baby to be placed on me and remain with me after birth.

I request my partner and myself be given as much skin-to-skin contact as possible and that I be given unlimited opportunities for breastfeeding.